Surgical cable system and method

ABSTRACT

A surgical cable system and method for securing surgical cable around a portion of a human element (e.g., bone) is described. The surgical cable system may include a connector and a tensioner. The connector may be adapted to hold a pin, positionable within the connector, such that the pin may secure the cable within the connector. The pin may be repositioned, after securing the cable, to allow the cable to move freely through the connector. The cable may be oriented within the connector such that the ends of the cable are perpendicular or parallel with respect to each other. The tensioner is preferably adapted to vary the tension of the cable. The cable may be passed through the connector, around a portion of a human bone, and back through the connector. The cable may be tensioned by use of the tensioner and secured into position within the connector.

This appln is a division of Ser. No. 09/919,127 filed Aug. 26, 1997 now5,964,769.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention generally relates to surgical cable systems andthe like. More particularly, an embodiment of the invention relates to amethod and apparatus for securing surgical cable around a portion of ahuman bone.

2. Description of the Related Art

Surgical cables are used in a variety of surgical procedures, someexamples include: spine surgery; total hip arthroplasty; fracturefixation; closure of the sternum following open heart surgery; andoral/facial surgery to repair mandibular fractures. In these and othersurgical procedures the cable may be used to set and secure boneportions in the proper orientation during the healing process.

Fractures of the vertebrae in the spinal column are very difficult toimmobilize, often requiring the use of internal pins, cables and/orrods. One frequently used procedure involves wiring the fracturedvertebra to one or more adjacent vertebrae to secure the vertebra in anideal position for healing. Another method involves wiring the fracturedvertebra to a rod that is similarly joined to other vertebrae. Both ofthese methods, as well as other techniques for spinal repair, rely onthe use of cables which are secured around a portion of a vertebra.

A number of methods for encircling bone portions with surgical cableshave been developed. Most of these techniques involve passing a cablearound a portion of the bone and securing the cable in position using acrimp. Example of cabling apparatus and methods are illustrated in U.S.Pat. Nos. 4,966,600; 5,395,374; 5,415,658; 5,423,820, and 5,569,253.Each of these patents is incorporated by reference as if fully set forthherein.

The Acromed™ Cable System by Songer, as shown in U.S. Pat. No.4,966,600, represents a cabling system that relies on the use of a metalcrimp member to secure a cable in a loop. In one embodiment of theAcromed™ system a crimp member is affixed to one end of the cable. Thecable may then be passed partially through a connector. The crimp membermay inhibit the cable from passing entirely through the connector. Thecable may then be looped around the bone portion and passed againthrough the connector. A tensioning device is used to tighten the cablearound the bone portion, and another crimp member is applied to theportion of the wire extending out from the connector to fix the cable inposition.

The Acromed™ system relies on crimp members to attempt to irreversiblysecure the cable in position. This feature may present difficulties if anumber of cables are used in series since it is often necessary toretighten some of the cables as other cables are added. To overcome thisproblem a double crimp technique is commonly used. In this technique thecable is passed through two crimp members before the cable is tensioned.After tensioning, the top crimp member may be affixed to the cable. Whenthe cable becomes loosened, it may be re-tensioned and the lower crimpmember affixed to the cable. The upper crimp member may be trimmed offafter the second crimp member is fastened to the cable. A disadvantageof this approach is that the number of re-tensions that may be performedis determined by the number of crimp members attached to the cablebefore the initial tensioning. If additional re-tensioning is requiredafter the last crimp member has been attached to the cable, the cablemay need to be removed and a new cable attached.

An orthopedic cable apparatus manufactured by Danek Medical Inc., asshown in U.S. Pat. Nos. 5,395,374 and 5,423,820, appears to overcomethese problems. The apparatus consists of three separate parts: adouble-apertured L-shaped crimp; a cable clamp; and a tensioning tool.The Danek system affixes one end of the cable to the double-aperturedL-shaped crimp. The cable is then looped around the bone portion andpassed through the other aperture of the L-shaped crimp. The cable isthen passed through a cable clamp, and further through a tensioner. Thetensioning device is used to tighten the cable around the vertebra. Oncethe appropriate tension is achieved the cable clamp is tightened totemporarily fix the cable in position. Since the cable clamp acts as anon-permanent securing device, the user is free to re-tension the cablea number of times during use. When the user is finished, the cable isfixed into position by crimping the second crimp portion of the L-shapedcrimp onto the cable. The Danek cabling system avoids the need formultiple crimps, as used by the Acromed™ system, however, it stillrelies on crimps to secure the cable in position.

A disadvantage to the use of crimps for securing a cable in position isthat the crimps may be highly unreliable. The crimps are typicallycompressed by the user to affix them to the cable. However, it may bevery difficult to control the percentage of deformation of the crimpsuch that a predictable and consistent amount of deformation may beproduced. If the crimp is over deformed some of the cable strands may besheared off, reducing the strength of the cable at the connection.Conversely, if the crimp is under deformed, the crimp may be incapableof preventing the cable from loosening after the procedure is finished.

Another problem encountered when using cable systems is that they forcethe cable into a specific position relative to the point where the cablecrosses itself. In some cases there is an advantage for the ends of thecable to be in a parallel orientation. Such an orientation allows aminimal profile of the connector. A low profile width is generallydesired to minimize sinus formation and soft tissue irritation. Theparallel orientation may sometimes cause a sharp bend in the cable,thereby creating stress in the system. To overcome this stress it isdesirable for the ends of the cable to be in a perpendicular orientationrelative to each other.

The Acromed™ apparatus, as shown in U.S. Pat. No. 4,966,600, may be usedin a number of ways in order to achieve the desired cable orientation.In one method the cable comprises a permanently looped eyelet end. Theother end of the cable may be through the eyelet to form a loop in whichthe ends of the cable are oriented in a perpendicular fashion. Inanother method the ends of the cable may be held in a parallelorientation by using a special connector designed for this purpose. TheDanek system, as shown in U.S. Pat. No. 5,569,253, is also designed foruse with the ends of the cable in a parallel or perpendicularorientation. The Danek system relies on the use of specially designedconnectors for each orientation. Neither the Acromed or the Daneksystems describe a single connector which would allow the cable to bepositioned in both a parallel and a perpendicular orientation.

The above mentioned methods and systems inadequately address, amongother things, the need for an apparatus that allows re-tensioning of thecable, as well as multiple orientations of the cable. The devices alsorely on crimps affixed to the cables to hold the cable in place. Asmentioned before, such crimps may be unreliable. It is thereforedesirable that a cable system be derived that incorporates, in a singledevice, the ability to allow the cable to be re-tensioned, anon-crimping securing mechanism, and multiple cable orientations.

SUMMARY OF THE INVENTION

An embodiment of the invention relates to a surgical cable system thatpreferably includes a connector adapted to hold a cable in a loop arounda human bone element and a tensioner. The connector may include aconnector body, a cable, and a pin adapted to secure the cable withinthe connector body. The term “cable” within the context of thisapplication is taken to mean an elongated flexible member. The term“pin” within the context of this application is taken to mean anelongated inflexible member.

The connector body preferably includes a first arm and a second arm, aninternal cavity, and at least two ducts. The first and second armspreferably extend from the same face of the connector body such that theconnector body is substantially U-shaped. The internal cavity preferablyruns longitudinally through the entire connector body and passes inbetween the two arms. The ducts preferably run transversally through theentire connector body, perpendicular to the internal cavity. The ductsare preferably oriented such that the ends of a cable, when the cable ispassed through the ducts to form a loop, may be oriented in asubstantially parallel orientation with respect to each other. The ductsare preferably located proximate to the internal cavity. The connectorbody may contain at least one aperture that is positioned between a ductand the internal cavity. The connector body preferably contains twoapertures that connect two separate ducts to the internal cavity. Theducts, the apertures, and the internal cavity are oriented with respectto one another such that a cable passing through the duct may extendthrough the aperture into the internal cavity.

The cable is preferably substantially flexible such that the cable mayform a loop for engaging a portion of a human bone. The cable ispreferably of a diameter such that the cable may pass freely through aduct. The cable is also preferably of a diameter such that it may extendfrom the duct, through the aperture, and into the internal cavity. Thecable preferably includes a tip which may inhibit the end of the cablefrom passing through the duct.

The pin comprises an upper portion and a lower portion. The upperportion may have a diameter that is substantially larger than thediameter of the internal cavity such that the upper portion of the pinis inhibited from passing through the internal cavity. The lower portionof the pin may have a diameter that is substantially less than thediameter of the internal cavity such that the lower portion of the pinfits within the internal cavity.

The pin may be positionable within the internal cavity where it mayexert a compressive force against the cable to secure the cable withinthe internal cavity. The cable may be looped around a bone and throughthe ducts. Subsequently, positioning the pin within the connector bodymay secure the cable in place. While the cable is secured the cable isno longer able to move within the connector. The bottom edge of the pinmay be deformed to secure the pin within the internal cavity.

More preferably, the pin is placed within the internal cavity of theconnector body before the cable is threaded. The pin may be securedwithin the internal cavity by deforming the bottom edge of the pin.Removal of the pin may be inhibited by the deformed bottom edge. The pinmay be substantially rotatable while positioned within the internalcavity. The upper portion of the pin may contain at least two flatedges, the edges being oriented on opposing sides of the upper portionof the pin. The distance between the two edges may be less than thedistance between the two arms extending from the connector body. Thearms may interact with the edges such that rotation of the pin ishindered. The pin may be rotatable when sufficient force is applied toovercome the hindering force of the arms.

The pin preferably includes two grooves. The grooves may be aligned withthe apertures, when the pin is inserted within the internal cavity, suchthat the cable may pass freely through the connector body. The pin mayalso be rotated, while the pin is inserted within the internal cavity,such that the grooves are perpendicular to the apertures. The rotationof the pin, after a cable has been threaded through the connector body,may exert a compressive force against the cable to secure it within theconnector body. The pin may be subsequently rotated to allow freemovement of the cable through the connector body.

The pin may further include an opening extending longitudinally throughthe entire pin. The opening preferably includes a top section and abottom section. The top section preferably has a diameter that issubstantially greater than the diameter of the end of the cable. Thelower section preferably has a diameter that is substantially less thanthe diameter of the tip of the cable. The cable may be passed throughthe opening, with the tip of the cable positioned within the opening,and further through a duct to form a loop. The pin may be positionedwithin the internal cavity to secure the cable in place, while the cableis passed through the opening and the duct. When secured in thisposition the cable may be oriented in a substantially perpendicularorientation.

The cable may be passed through the ducts of the connector body suchthat the ends of the cable are oriented in a substantially parallelorientation. Alternatively the cable may be passed through the openingof the pin and through a duct to form a loop, the ends of the cablebeing in a substantially perpendicular orientation.

The surgical cable system may also include a tensioner adapted to varythe tension of the cable and secure the cable. The tensioner preferablyincludes a body, a shaft for contacting the connector, a driver forpositioning the pin within the connector body, and an arm for adjustingthe shaft.

The shaft is preferably mounted within the body, such that it extendsfrom both sides of the body. The arm and the shaft are preferablyconnected such that the arm is capable of being adjusted to retract orextend the shaft from an end of the body. The body may include a stopperwhich secures the position of the shaft with respect to the body.

The shaft preferably includes a tip adapted to hold the connector. Thetip may include a recessed opening which is shaped to couple to theconnector. The shaft may also include an opening extendinglongitudinally through the shaft. The opening of the shaft is preferablyadapted to allow the driver to pass through the shaft and onto theconnector.

The body may include a cable clamp adapted to secure the cable against aportion of the body. The body preferably includes at least two cableclamps. The cable clamps may secure the cable against a portion of thebody after the cable is threaded through the connector and around aportion of a human bone. The shaft may engage the connector, after thecable has been secured with respect to the body, such that movement ofthe shaft causes the tension of the cable to vary.

The driver may include an end adapted to engage the pin of theconnector. The driver preferably includes a handle to allow the driverto be moved in a circular motion. The shaft preferably includes anopening, extending longitudinally through the shaft, that allows thedriver to engage the pin while the connector is in contact with theshaft. The driver may engage the pin such that rotation of the drivercauses the pin to rotate into a position which secures the cable withinthe connector. While the cable is secured the cable is no longer able tomove within the connector. Subsequent to securing the cable, the drivermay be rotated to cause the pin to move into a position which allows thecable to once again have mobility within the connector.

An advantage of the present invention is that the cable may be securedor movable within the connector as necessary.

Another advantage of the present invention is that the cable may besecured into position without the use of crimps.

Yet another advantage is that the present invention may allow the endsof the cable to be in a perpendicular orientation with respect to eachother or a parallel orientation with respect to each other.

BRIEF DESCRIPTION OF THE DRAWINGS

Further advantages of the present invention will become apparent tothose skilled in the art with the benefit of the following detaileddescription of the preferred embodiments and upon reference to theaccompanying drawings in which:

FIG. 1 depicts a side view of a connector,

FIG. 2 depicts a perspective view of a cable;

FIG. 3 depicts a cross sectional view of the connector as viewed fromthe side;

FIG. 4 depicts a cross sectional view of a pin as viewed facing a groovefrom the front face;

FIG. 5 depicts a side view of the pin;

FIG. 6 depicts a cross sectional view of the pin as viewed from thefront;

FIG. 7 depicts a top view of the connector with the cable forming a loopby entering a first face opposite to a second face from which it exits;

FIG. 8 depicts a top view of a connector with the cable forming a loopby entering the same face from which it exits;

FIG. 9 depicts a cross sectional view of the connector in a securedposition, with a portion of the cable residing in an opening of the pin,as viewed from the side of the connector;

FIG. 10 depicts a cross sectional view of the connector, with the cablebeing movable within the connector body, as viewed from the side;

FIG. 11 depicts a cross sectional view of the connector, with the cablebeing secured in an immobile position within the connector, as viewedfrom the side;

FIG. 12 depicts a cross sectional view of the connector, with the cablebeing movable within the connector body, as viewed from the bottom;

FIG. 13 depicts a cross sectional view of the connector, with the cablesecured in an immobile position within the connector body, as viewedfrom the bottom;

FIG. 14 depicts a perspective view of a tensioner;

FIG. 15 depicts a cross sectional view of a body of the tensioner, asviewed from the side;

FIG. 16 depicts a rear view of the body of the tensioner;

FIG. 17 depicts a cross sectional view of the tensioner, as viewed fromthe side;

FIG. 18 depicts a tip of a shaft of the tensioner, as viewed from thefront;

FIG. 19 depicts the tip of the shaft as viewed from the side;

FIG. 20 depicts a cross-sectional view of a bushing cover of thetensioner as viewed from the side of the bushing cover;

FIG. 21 depicts a side view of the bushing cover;

FIG. 22 depicts a top view of the bushing cover; and

FIG. 23 depicts a cross sectional partial view of the bushing cover witha cable clamp, as viewed from the side.

While the invention is susceptible to various modifications andalternative forms, specific embodiments thereof are shown by way ofexample in the drawings and will herein be described in detail. Itshould be understood, however, that the drawings and detaileddescription thereto are not intended to limit the invention to theparticular form disclosed, but on the contrary, the intention is tocover all modifications, equivalents and alternatives falling within thespirit and scope of the present invention as defined by the appendedclaims.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

FIG. 1 depicts an embodiment of a connector 20 constructed according tothe teachings of the present invention. The connector 20 includes aconnector body 24 and a pin 22. A cable 10 may be passed through theducts 26 to form a loop for engaging a portion of a human bone. Thecable 10 may be looped around a variety of human bone portions involvedin various surgical procedures. The surgical procedures which may makeuse of a surgical cable system include, but are not limited to: spinesurgery; total hip arthroplasty; fracture fixation; closure of thesternum following open heart surgery; and oral/facial surgery to repairmandibular fractures. The cable 10 is preferably used for engaging aportion of the human spine.

The term “cable” within the context of this application is taken to meanan elongated flexible member. An embodiment of the cable 10 isillustrated in FIG. 2. The cable 10 includes a leader portion 12, a mainportion 14, and a tip 16. The main portion 14 is preferably comprised ofa substantially flexible stranded metal wire. The main portion 14 may becomprised of any substantially flexible material including, but notlimited to, steel, nylon, or various plastics. The main portion 14 ispreferably made of titanium or stainless steel.

The cable 10 preferably has a leader portion 12 attached to an end ofthe cable. The leader portion 12 may comprise a non-stranded wire thatis substantially less flexible than the main portion 14. The leaderportion 12 may be comprised of any substantially flexible materialincluding, but not limited to, steel, nylon, or various plastics. Theleader portion 12 is preferably made of titanium or stainless steel. Theleader portion 12 is preferably made of the same material as the mainportion 14 of the cable 10. The leader portion 12 may be used to guidethe cable 10 around the bone and through the various openings of theconnector 20.

The cable 10 may include a tip 16 attached to an end of the cable. Thetip 16 is preferably of a diameter that is substantially larger than thediameter of the main portion 14. The tip 16 may be made of the samematerial as the main portion. The tip 16 is preferably made of titaniumor stainless steel. The tip 16 may be larger than the diameter of theducts 26, (shown in FIG. 1), such that the tip 16 is inhibited frompassing through the ducts. Thus, tip 16 may function to prevent thecable 10 from passing entirely through the ducts 26.

The cable 10 is preferably made by twisting together multiple wirestrands around a cable core. The wire strands are preferably made bytwisting six filaments around a central filament in a helicalorientation. The filaments may be made by reducing the diameter of awire to a thickness of less than 0.005 inches, and more preferably to adiameter of 0.003 inches. The cable core is preferably made by twistingsix wire strands over a central strand in a helical orientation. Thecable 10 is preferably made by twisting twelve strands over the cablecore. After the strands are twisted to form the cable 10, the cable maybe hammered repeatedly to give a smooth surface. The cable 10 may be cutinto the appropriate length by a cutting apparatus. The cable 10 ispreferably cut by a laser. By applying tension on the cable 10 duringthe cutting process an end of the cable may be formed into an enlargedtip 16. The leader portion 12 may be welded onto an end of the cable 10before use. The cable may be cleaned repeatedly during the manufacturingprocedure.

FIG. 3 depicts a cross sectional view of the connector body 24 of theconnector 20. The connector body 24 preferably includes an internalcavity 28 for holding a pin 22 within the connector body 24. Theinternal cavity 28 may be substantially cylindrical in shape andpreferably passes longitudinally through the entire connector body 24.The connector body 24 may include a duct 26 that passes transversallythrough the entire connector body. The duct 26 is preferably orientedsubstantially perpendicular to the internal cavity 28. The connectorbody 24 preferably includes at least two ducts 26 that passtransversally through the entire connector body. The ducts 26 preferablycommunicate with the internal cavity 28 via an aperture 30. The ducts 26are preferably positioned such that a cable 10 lying within the duct mayextend into the internal cavity 28.

The pin 22 preferably includes an upper portion 36 and a lower portion40, as depicted in FIG. 4. The pin 22 may also include a transitionportion 38 oriented between the upper portion 36 and the lower portion40. The upper portion 36 is preferably of a diameter substantiallylarger than the diameter of the lower portion 40. The upper portion 36is preferably of a diameter such that it is incapable of passing intothe internal cavity 28. The lower portion 40 of the pin 22 is preferablyof a diameter such that the lower portion may fit into the internalcavity 28 (shown in FIG. 2). The diameter of the transition portion 38may be variable, becoming narrower in a direction from the upper portion36 toward the lower portion 40. The bottom of the pin 43 may bedeflected outward to substantially secure the pin 22 within the internalcavity 28.

In another embodiment, the pin 22 preferably includes two grooves 42, asdepicted in FIG. 5. The grooves 42 may be substantially rectangular inshape, comprising a width that is substantially larger than the diameterof the cable 10. The grooves 42 are preferably oriented on opposingsides of the lower portion 40 of the pin 22. Referring to FIG. 9, thepin 22 may lie within the internal cavity 28 such that the grooves 42lie in the plane defined by the ducts 26. The grooves 42 may besubstantially aligned with the ducts 26, with an aperture 30 positionedbetween each duct and groove. The pin 22 may be oriented within theinternal cavity 28, with the grooves 42 substantially aligned with theducts 26, such that the cable 10 may pass freely through the connectorbody 24. The pin 22 may also be oriented within the internal cavity 28,with the grooves 42 positioned substantially perpendicular to the ducts26, such that the cable 10 is secured within the connector body 24.

In another embodiment, the pin 22 preferably includes an opening 44, asdepicted in FIG. 6. The opening 44 is preferably substantiallycylindrical in shape and preferably passes longitudinally through theentire pin 22. The pin may surround a portion of the opening such thatthe opening is U-shaped or V-shaped. The pin preferably surrounds theentire opening. The opening 44 preferably includes an upper portion 46and a lower portion 48. The pin 22 may also include a transition portion47 oriented between the upper potion 46 and the lower portion 48. Theupper portion 46 is preferably of a diameter substantially larger thanthe diameter of the lower portion 48. The diameter of the upper portion46 is preferably substantially larger than the diameter of the tip 16 ofcable 10. The diameter of the lower portion 48 is preferablysubstantially smaller than the diameter of the tip 16 of cable 10. Inthis manner, the opening 44 may prevent a cable 10, having a tip 16,from passing completely through the opening.

The upper portion 46 of the opening 44 may be chosen to couple with anysuitable device adapted to apply a torsional force. The upper portion 46may be substantially rectangular for receiving a flat head torsioningdevice, such as a screw driver. The upper portion 46 may also besubstantially cross shaped for receiving a cross shaped head of atorsioning device, such as a Phillips head screwdriver. The upperportion 46 is preferably hexagonal in shape for receiving a hexagonalhead of a torsioning device, such as an Allen wrench.

FIG. 7 depicts a connector 20 with a cable 10 threaded through theconnector body 24 to form a loop according to one embodiment. The cable10 is preferably threaded through a duct 26, around a human boneelement, and back through a separate duct 26 to form a loop. The loop isformed such that the ends of the cable 10 lie in a substantiallyparallel orientation with respect to each other. The cable 10 ispreferably threaded through a duct 26, around a human bone element, andback through another duct to form a loop, reentering the connector body24 from the face 35 on the side opposite to the face 33 which the cableinitially exited. The pin 22 may be inserted within the connector body24, after the cable 10 has been looped around a human bone element andpassed through the connector body 24 to secure the cable within theconnector body. The pin 22 may be removed from the connector body 24,subsequent to securing the cable 10 within the connector body, to allowthe cable to be moved within the connector body. Removal of the pin 22may be prevented by deforming the bottom of the pin.

FIG. 8 depicts another embodiment in which the cable 10 is preferablythreaded through a duct 26, around a human bone element, and backthrough a separate duct to form a loop, reentering the connector body 24from the same face 33 of the connector body that the cable initiallyexited. The pin 22 may be inserted within the connector body 24 tosecure the cable 10 within the connector body. While the cable 10 issecured the cable is no longer able to move within the connector 20. Thepin 22 may be removed from the connector body 24, subsequent to securingthe cable 10 within the connector body, to allow the cable to be movedwithin the connector body.

FIG. 9 depicts another embodiment in which the cable 10 is preferablythreaded through the opening 44, around a human bone element, and backthrough a duct 26 to form a loop. In this manner, the ends of the cable10 may lie in a substantially perpendicular orientation with respect toeach other (not shown). The pin 22 may be inserted within the connectorbody 24 to secure the cable 10 within the connector body. The pin 22 maybe removed from the connector body 24, subsequent to securing the cable10 within the connector body, to allow the cable to be movable withinthe connector body. Tension on the cable 10 may pull the tip 16 of thecable against the lower portion 48 of the opening 44. In this manner,the cable 10 may be prevented from moving within the opening 44.

The pin 22 may be positioned within the internal cavity 28 before thecable 10 is threaded through the ducts 26. The cable 10 may be threadedthrough the ducts 26 of the connector body 24 while the pin 22 ismounted within the internal cavity 28. The pin 22 is preferably orientedsuch that the grooves 42 of the pin are substantially aligned with theducts 26, as depicted in FIGS. 10 and 12. The pin 22 may be rotated,subsequent to the cable 10 being passed through the connector body 24,such that the grooves 42 are substantially perpendicular to the ducts26. As a result, the ungrooved portion of the pin 22 may compress thecable 10 against the connector body 24, securing the cable, as depictedin FIGS. 11 and 13. Subsequent to securing the cable 10 within theconnector body 24, the pin 22 may be further rotated such that thegrooves 42 are once again aligned with the ducts 26. In this manner, thecable 10 may be repeatedly moved and secured within the connector body24.

In another embodiment, the cable 10 may be threaded through the pin 22and through a duct 26 of the connector body 24, as depicted in FIG. 9.The pin 22 may be rotated within the connector body 24 to secure thecable 10 in an immobile position within the connector body. Subsequentto securing the cable 10 in an immobile position within the connectorbody 24, the pin 22 may be further rotated such that the cable may againbe movable within the connector body. Tension on the cable 10 may pullthe tip 16 of the cable against the lower portion 48 of the opening 44.In this manner, the cable 10 may be prevented from moving within theopening 44.

The connector body 24 preferably has two substantially flat arms 32extending out from the top face of the connector body, as depicted inFIG. 9. The arms 32 are preferably oriented opposite to each other, andthe internal cavity 28 is preferably located between the two arms. Theupper portion 36 of the pin 22 may have at least two substantially flatedges 34. The upper portion 36 of the pin 22 more preferably has foursubstantially flat edges 34 (shown in FIG. 7). The edges 34 arepreferably oriented on opposing sides of the upper portion 36 of the pin22. The pin 22 may be mounted within the internal cavity 28 such thatthe edges 34 are contained by the arms 32 of the connector body 24. Thearms 32 may interact with the edges 34 such that rotation of the pin 22is hindered. The pin 22 may be rotatable when sufficient force isapplied to the pin to overcome the hindering force of the arms 32.

As illustrated in FIG. 10 the pin 22 may be inserted within the internalcavity 28 and the pin bottom 43 deflected outward. The diameter of thebottom 45 of the internal cavity 28 is preferably tapered, becomingwider in a direction toward the bottom 45 of the connector body 24. Thedeflection of the bottom 43 of pin 22 is tapered to match the taperingof the internal cavity 28. The pin 22 is preferably rotatable within theinternal cavity 28. The lower portion 40 of the pin 22 is preferably ofa diameter such that, when positioned within the internal cavity 28, thelower portion may compress the cable 10 against the wall of the duct 26,securing the cable in place.

The cable 10 is preferably formed into a loop and tensioned prior tosecuring the cable within the connector body 24. When the cable 10 isunder tension, the corners of the edge 34 of the pin 22 may rest uponthe inner faces of the arms 32. The force exerted by the arms 32 uponthe corners of the edges 34 may prevent the pin 22 from rotating due tothe tension of the cable 10. The pin 22, however, may be rotated by anoperator to a position which allows the cable 10 to be movable throughthe connector body 24. The force required by the operator to move thepin 22 into an unsecured position is preferably greater than therotational force exerted on the pin by the cable 10 when in a securedposition.

The surgical cable system preferably includes a tensioner 50 adapted tovary the tension of the cable 10 and secure the cable within theconnector 20. A preferred embodiment of the tensioner 50 is depicted inFIG. 14. The tensioner 50 preferably includes a body 52, a shaft 58 forcontacting the connector 20, a driver 56 for positioning the pin 22within the connector 20, and an arm 54 for adjusting the position of theshaft 58. The parts of the tensioner 50 may be made of a variety ofsubstantially inflexible materials including, but not limited to,instrument grade stainless steel, aluminum, and various plastics.

FIG. 15 depicts a cross sectional side view of the body 52. The body 52is preferably substantially rectangular and hollow. The body 52preferably includes a substantially circular front opening 82 and asubstantially oval rear opening 84. The body 52 may also include abushing holder 86 extending from the front edge 81 of the body. Thefront opening 82 may pass through the bushing holder 86. The frontopening 82 and the rear opening 84 may be aligned such that a rigid,elongated member may be passed through both openings. The front edge 81of the body 52 may be uncovered allowing insertion of the arm 54 withinthe body.

FIG. 16 depicts a preferred embodiment of the rear opening 84 of thebody 52. The rear opening 84 preferably comprises two curved sectionsand two flat sections. The curved sections may be oriented at the topand the bottom of the rear opening 84. The flat sections may connect thetop curved section to the bottom curved section to form a substantiallyoval opening.

The arm 54 may be substantially hollow and is preferably mounted withinthe hollow portion of the body 52, as depicted in FIG. 17. The arm 54may be held in place by the arm pin 72. The arm pin 72 may besubstantially cylindrical and hollow. The arm pin 72 may extend throughthe entire arm 54 and partially into the sides of the body 52. The armpin 72 may be mounted within the body 52 such that the arm 54 ispivotable about the arm pin in a range of about 45 degrees. The arm 54may be stopped in a forward position when the top 53 of the arm comesinto contact with the body 52, as depicted in FIG. 17. The arm 54 may besimilarly stopped in a rear position when the bottom 55 of the arm 54comes into contact with the body 52. The sides of the arm 54 preferablyextend above the top of the arm to form a substantially U-shaped pocket.The U-shaped pocket may be adapted to hold a push tab pin 88 that may bemounted over the top of the arm 54 extending into the sides of the arm.

Turning to FIG. 17, the push tab 64 may be substantially rectangular.The push tab 64 preferably includes a substantially circular aperture.The push tab 64 may rest on the front portion of the push tab pin 88.The aperture of the push tab 64 is preferably sized such that the shaft58 may be passed through the aperture. The push tab 64 is preferablyplaced within the hollow portion of the body 52. The shaft 58 ispreferably fitted through the aperture of the push tab 64, and the lowerportion of the push tab is preferably seated against the push tab pin88. The arm spring 92 may also lie on the shaft 58, preferablypositioned between the push tab 64 and the front 81 of the body 52.

The arm 54 is preferably pivotable about the arm pin 72 such that abottom portion 55 of the arm may be moved toward the rear 83 of the body52. Rearward motion of the arm 54 preferably causes the push tab pin 88to move toward the front 81 of the body 52. Push tab 64 preferably restsagainst the push tab pin 88. Thus, movement of the push tab 64 towardthe front 81 preferably makes the push tab pin 88 move in a similardirection. As a result, the push tab 64 may engage the shaft 58,propelling the shaft through the front opening 82 of the body 52.Concurrent with the movement of the arm 54, the push tab 64 may alsocompress the arm spring 92. In the absence of any pressure on arm 54,the arm spring 92 preferably expands such that the push tab 64, the pushtab pin 88, and the arm 54 are returned to their original positions.

The body 52 may further include a lock tab 62 and lock spring 94. Thelock tab 62 may be substantially rectangular. The lock tab 62 preferablyincludes a substantially circular aperture. The lock tab 62 may extenddownward from the top of the body 52, as depicted in FIG. 17. Theaperture is preferably sized such that the shaft 58 may be passedthrough the aperture. The lock spring 94 may also lie on the shaft 58,preferably positioned between the lock tab 62 and the body 52. The lockspring 94 preferably exerts a force on the lock tab 62, forcing it awayfrom the rear 83 of the body 52. Movement of the lock tab 62 in thisdirection is preferably restricted when the lower portion of theaperture comes into contact with the shaft 58. The force exerted by thelock tab 62 upon the shaft 58 may restrict the rearward motion of theshaft through the body 52.

The lock tab 62 may be moved toward the front 81 of the body 52 suchthat the aperture no longer comes into contact with the shaft 58. Whenoriented in this forward position the lock tab 62 may no longer restrictthe rearward motion of the shaft 58. The lock tab 62 is preferably movedinto the forward position to allow the shaft 58 to be moved in arearward direction within the body 52. Movement of the lock tab 62toward the front of the body 52 may also compress the lock spring 94.When the pressure being applied to the lock tab 62 is released, the lockspring 94 preferably pushes the lock tab 62 back into its startingposition.

The shaft 58 may be a variety of shapes including, but not limited tocylindrical, oval or trapezoidal. The shaft 58 is preferablysubstantially cylindrical and hollow. The shaft 58 may include two flatedges 59 (shown in FIG. 14) that run longitudinally along the entirelength of the shaft 58. The edges 59 are preferably oriented on opposingsides of the shaft 58, giving the shaft a substantially oval shape.Referring back to FIG. 16, the rear opening 84 of the body 52 ispreferably shaped to allow a shaft 58 of complimentary shape to passthrough the rear opening. The rear opening 84 is preferably shaped toinhibit rotation of the shaft 58 within the body 52. The width of thehollow portion of the shaft 58 is slightly greater than the diameter ofthe driver 56, thereby allowing the driver to freely pass through theshaft. The shaft 58 may also include a knob 96 at an end of the shaft,as depicted in FIG. 17. The knob 96 may be a threaded nut which isscrewed onto the shaft 58. The knob 96 may be used to position the shaft58 within the body 52.

The shaft 58 preferably includes a tip 80 proximate an end of the shaftwhich is adapted to hold the connector 20. The tip 80 is preferablylocated at the end of the shaft 58 which extends from the front 81 ofthe body 52. FIG. 18 depicts a preferred embodiment of the tip 80. Thetip 80 may be slightly larger than the diameter of the shaft 58. The tip80 preferably includes two indentations 78 running along the outsidesurface of the tip. The indentations 78 are preferably oriented onopposing sides of the tip 80. The indentations 78 are preferably sizedsuch that the width of the indentations are substantially greater thanthe width of the cable 10. The depth of the indentations 78 ispreferably tapered, becoming shallower in a direction from the end ofthe shaft 58 toward the body 52.

The tip 80 may include a recessed opening which is adapted to couplewith the connector 20. The front of the tip 80 is depicted in FIG. 19.The front of the tip 80 preferably contains a first slot 96 and a secondslot 98. The first slot 96 preferably runs across the end of the tip 80,in the plane of the tip 80 formed by the two indentations 78. The secondslot 98 preferably runs in a substantially perpendicular orientation tothe first slot 96. The depth of the second slot 98 may be substantiallygreater than the depth of the first slot 96. The connector 20 may bemounted within the tip 80 such that the ducts 26 are oriented toward theindentations 78 of the tip. This arrangement preferably allows the cable10 to freely pass through the connector 20 and along the indentations 78while the connector 20 is mounted within the tip 80.

The body 52 may also include a substantially cylindrical and hollowbushing cover 66, as depicted in FIGS. 20, 21, and 22. The bushing cover66 preferably includes an upper chamber 100, a lower chamber 102, adivider 104 and two arms 106. The upper chamber 100 is preferably sizedsuch that the bushing cover 66 may be inserted over the bushing holder86, as depicted in FIG. 17. The distance between the divider 104 and thetop 101 of the bushing cover 66 may be substantially less than thedistance that bushing holder 86 extends out from the body 52. Thedistance is set such that a space may exist between the bushing cover 66and the front edge 81 of the body 52. The divider 104 preferably extendspartially into the interior of the bushing cover 66, at a distanceallowing the shaft 58 to pass through the bushing cover. The lowerchamber 102 is preferably sized to allow the bushing 60 and the bushingspring 90 to be inserted together within the chamber, as depicted inFIG. 17. The arms 106 preferably extend from opposing sides of thebushing cover 66. The end of each arm 106 is preferably shaped into asubstantially U-shaped groove, as depicted in FIG. 22. The bushingspring 90 is preferably sized to fit within the lower chamber 102. Thebushing spring 90 is preferably sized to fit over the bushing 60.

Referring back to FIG. 17, the body 52 may include a substantiallycylindrical and hollow bushing 60. It is preferred that the width of thehollow portion of the bushing 60 and the diameter of the shaft 58 besubstantially equal. The shape of the hollow portion is preferablycomplimentary to the shape of the shaft 58. The hollow section mayextend through the longitudinal axis of the bushing 60. The bushing 60is preferably mounted within the bushing holder 86. The engagement ofthe bushing 60 with the shaft 58, while the bushing 60 is mounted withinthe bushing holder 86, preferably minimizes the lateral movement of theshaft within the body 52. The bushing holder 86 preferably containsfemale threading. The bushing 60 may include a threaded end, sized tofit the female threading of the bushing holder 86. The threaded end ofthe bushing 60 preferably engages the bushing holder 86 such thatrotation of the bushing in a tightening direction moves the threaded endinto the bushing holder.

The bushing 60 is preferably adapted to hold the bushing cover 66 ontothe bushing holder 86, whereby the bushing cover is freely rotatableabout the bushing holder. The bushing 60 preferably includes a flangedend. The bushing cover 66 and the bushing spring 90 are preferablyplaced on the bushing holder 86, such that the bushing spring lieswithin the lower chamber 102 of the bushing cover. The bushing spring 90may rest against a front edge of the bushing holder 86. The bushing 60may be fastened by screwing the threaded end into the threaded portionof the bushing holder 86. The flanged end of the bushing 60 preferablypresses against the bushing cover 66 to hold the bushing cover againstthe bushing holder 86. The flanged end of the bushing 60 may alsocompress the bushing spring 90. The bushing spring 90 is adapted toprevent the bushing 60 from being overtightened. Overtightening of thebushing 60 might hinder or prevent rotation of the bushing cover 66about the bushing holder 86.

FIG. 23 depicts a portion of the bushing cover 66 which preferablyincludes a cable clamp 68 adapted to secure a cable 10 against a portionof the bushing cover. The bushing cover 66 preferably includes at leasttwo cable clamps 68. The cable clamp 68 preferably includes a lever 76,a pin 70, and a spring 108. The lever 76 may include a substantiallyhollowed out portion 109 and a clamping portion 110. The lever 76 ispreferably connected to an arm 106 of the bushing cover 66 with asubstantially cylindrical pin 70. The pin 70 may extend through both thelever 76 and the U-shaped groove of the arm 106. The pin 70 may bemounted within the U-shaped groove of the arm 106 such that the lever 76is pivotable about the pin.

The spring 108 preferably lies on the pin 70 and extends into thebushing cover 66 and along the lever 76. The spring 108 preferablyextends into the hollow portion of the lever 76. In its resting positionspring 108 preferably exerts a force against the inside edge of thehollow portion 109 such that the lever 76 is moved away from the bushingcover 66. When the hollow portion 109 extends away from the bushingcover 66, the clamping portion 110 is preferably disposed against thebushing cover. When pressed with sufficient force the lever 76 may pivotaround the pin 70 such that the clamping portion 110 is no longer incontact with the bushing cover 66. The cable 10 may be passed under thelever 76 while the clamping portion 110 is in its raised position. Thedepression of the clamp lever 76 preferably compresses the spring 108.Removal of the force being applied to the lever 76 preferably allows thespring 108 to expand, thereby forcing the clamping portion 110 to returnto the bushing cover 66. If a cable 10 is present when the force isreleased from the lever 76, the clamping portion 110 may become pressedagainst the cable, securing it in place against the bushing cover 66.

The arm spring 92 and the lock spring 94 may be compression springs. Thespring 108 of the cable lock 68 is preferably a torsion spring. Thebushing spring 90 is preferably a spring washer. The term “springwasher” in the context of this application is meant to mean a springadapted to apply a predetermined force on adjacent members in anassembly.

Referring back to FIG. 17, the driver 56 may include a handle 114attached to the elongated member 112 of the driver. The handle 114 ispreferably a rod that is attached to the elongated member 112 in aperpendicular orientation, such that the driver 56 is substantiallyT-shaped. The handle 114 may be rotated to allow the driver 56 to bemoved in torsionally. The elongated member 112 may be substantiallylonger than the shaft 58. The driver 56 preferably includes a head 116adapted to engage the pin 22 of the connector 20. The head 116 ispreferably located at an end of the elongated member 112 opposite to thehandle 114. The shape of head 116 may be chosen to couple with a pin 22of suitably recessed shape such that rotation of the handle may apply atorsional force to the pin. The head 116 is preferably hexagonal inshape for coupling with the hexagonal recess of the upper portion 46 ofthe opening 44 of the pin 22.

The shaft 58 may be substantially cylindrical and hollow. The hollowportion of the shaft 58 is preferably sized such that the elongatedportion 112 of the driver 56 may be passed through the center of theshaft. The shaft 58 is configured such that the driver 56 may engage thepin 22 while the connector 20 is in contact with the shaft. The driver56 may engage the pin 22 such that rotation of the driver 56 causes thepin to rotate. The driver 56 preferably engages the pin 22 such thatrotation of the driver causes the pin 22 to rotate into a position whichsecures the cable 10 within the connector 20. Once the cable 10 has beenclamped into this position, the driver 56 may engage the pin 22 suchthat rotation of the driver causes the pin to rotate into a positionwhich allows movement of the cable within the connector 20.

The surgical procedure for implanting a surgical cable system around aportion of a human bone includes forming a loop around the desiredportion, tensioning the cable 10, and securing the cable within theconnector 20. The loop is preferably formed by threading the cable 10through the connector 20, around a portion of the human bone and backthrough the connector. In an embodiment, the cable 10 may be loopedaround two or more adjacent vertebra. In another embodiment the cable 10may be passed around a vertebra and a spinal fixation device. The spinalfixation device is adapted to immobilize a section of the human spineand may be a rod.

As depicted in FIG. 7, the cable 10 may be passed through a duct 26 ofthe connector 20, around a portion of the human bone, and back through adifferent duct 26. In an embodiment, the cable 10 may be threadedthrough the connector 20 exiting from the rear face 33 of the connectorbody 24. After encircling a bone member the cable 10 may reenter theconnector body 24 from the front face 35. In another embodiment,depicted in FIG. 8, the cable 10 may be threaded through the connector20 exiting from the rear face 33 of the connector body 24. Afterencircling a bone member the cable 10 may reenter the connector body 24from the rear face 33, forming a loop around the bone member. The endsof the cable 10 may extend out from the connector body 24. The ends maybe in a substantially parallel orientation with respect to each other.

In another embodiment, the cable 10 may include tip 16, as depicted inFIG. 1. Referring again to FIG. 7, the tip 16 is preferably of adiameter that is substantially larger than the diameter of a duct 26.The tip 16 preferably inhibits the cable 10 from passing completelythrough the duct 26. The cable 10 may be threaded through the connector20, exiting from the rear face 33 of the connector body 24. The cable 10is preferably threaded through the connector body 24 until the tip 16 isdisposed against the front face 34 of the connector body 24. Afterencircling a bone member, the cable 10 may reenter the connector body 24from the front face 35. In another embodiment, the cable 10 may reenterthe connector body 24 from the rear face 33 of the connector body. Asthe cable 10 is tensioned, the tip 16 may be disposed against the frontface 35 of the connector body 24. The tip 16 may remain disposed againstthe face of the connector body 24 until the tension of the cable 10 isreleased.

In an alternate embodiment, (referring to FIG. 13) the tip 16 ispreferably of a diameter that is substantially larger than the diameterof an opening 44 of pin 22. The tip 16 preferably inhibits the cable 10from passing completely through the opening 44. The cable 10 ispreferably threaded through the opening 44 until the tip 16 is disposedagainst the lower portion 48 of the opening. After encircling a humanbone member, the cable 10 may be passed into the connector body 24through one of the ducts 26. The pin 22 is preferably oriented to allowthis passage of the cable 10 through one of the ducts 26. As the cable10 is tensioned, the tip 16 may be disposed against lower portion 48 ofthe opening 44. The tip 16 may remain disposed against the lower portion48 of the opening 44 until the tension of the cable 10 is released.

A tensioner 50 may be used to increase the tension on a cable 10 afterit has been encircled around a human bone member. The preferredembodiment of the tensioner 50 is illustrated in FIG. 14. The tensioner50 may be prepared to receive the connector 20 by positioning the shaft58 such that the tip 80 is positioned proximate to the front of thebushing 60. The shaft 58 may be positionable within the body 52 whilethe lock tab 62 is in a forward position. The lock tab 62 may be movedinto the forward position by applying pressure to the rear face of thelock tab 62. Pressure on the lock tab 62 may be released allowing thelock tab to move away from the tensioner body 52. In this releasedposition the lock tab 62 may prevent the rearward movement of the shaft58.

After the cable 10 is looped around a human bone member and through theconnector 20, the connector may be engaged by the tip 80 of thetensioner 50. The connector 20 is engaged by the tip 80 such that thefront and rear faces of the connector are aligned with the indentations78 (see FIG. 19). The top of the connector 20 may be substantiallypositioned within the tip 80. The pin 22 may be mounted within theconnector body 24, and the connector body may be engaged by the tip 80.

A cable end is preferably positioned along the indentations 78 of thetip 80. The cable end is preferably clamped to the tensioner 50 by thecable clamp 68. The clamping portion 110 of the cable clamp 68 may bedisposed against the side of the bushing cover 66 while in the restingposition. When pressed with sufficient force the lever 76 may pivotaround the arm pin 70 such that the clamping portion 110 is no longer incontact with the bushing cover 66. The cable 10 may be passed under thelever 76 while the clamping portion 110 is raised. Removal of the forcebeing applied to the lever 76 preferably causes the clamping portion 110to move toward the bushing cover 66. As a result, the clamping portion110 may become pressed against the cable, thereby securing it in placeagainst the bushing cover 66. In an embodiment, one end of the cable 10is preferably secured to the bushing cover 66, using the cable clamps68. In another embodiment, both ends of the cable 10 are preferablysecured to the bushing cover 66.

Pressure may then be applied to the arm 54 of the tensioner 50 to pivotthe arm around the arm pin 72 such that the arm moves in a directiontoward the body 52 of the tensioner 50. Movement of the arm 54 towardthe body 52 may be accompanied by movement of the shaft 58 away from thebody 52. The angle to which the arm 54 is pivoted may determine thedistance the shaft 58 extends from the body 52. When the pressure on thearm 54 is released, the arm preferably moves away from the body 52.Movement of the arm 54 away from the body 52 preferably does not effectthe position of the shaft 58. With the cable 10 secured to the tensioner50, movement of the shaft 58 away from the body 52 preferably pulls thecable 10 through the connector 20 in a direction away from theconnector. As a result, the tension on the cable 10 preferablyincreases. The arm 54 may be repeatedly pressured and released as manytimes as necessary to achieve the desired tension.

In one embodiment, a pin 22 may be inserted into the connector body 24,after the cable 10 has been tensioned, to secure the cable within theconnector 20. The driver 56 may be used to insert the pin 22 into theconnector body 24. In an alternate embodiment, the pin 22 may be placedin the connector body 24 prior to tensioning the cable 10. The pin 22may be positioned within the tip 80. The driver 56 may be insertedthrough the center of the shaft 58 until it engages the pin 22. The endof the driver 56 is preferably shaped to fit within the opening 44 ofthe pin 22. The rotation of the driver 56 may be accompanied by rotationof the pin 22 while the driver is inserted within the opening 44. Thepin 22 is preferably oriented such that the cable 10 may pass throughone of the ducts 26. Rotation of the pin 22 may alter the orientation ofthe pin such that the pin secures a portion of the cable 10 within theconnector body 24. The pin 22 is preferably rotated 90° into a securingorientation. Rotation of the pin 22 is preferably performed after thecable 10 has been tensioned. In this manner, the diver 56 may rotate thepin 22 to secure a portion of the cable 10 within the connector 20without removing the connector from the tip 80.

After securing the cable 10 within the connector 20 the tensioner 50 maybe disengaged from the connector. The cable 10 may be removed from thecable clamp 68 before disengaging the tensioner 50. To remove the cable10, pressure may be applied to the lever 76, causing the lever to liftfrom the bushing cover 66. As a result, the securing force exerted bythe clamping portion 110 is removed, allowing the cable 10 to be removedfrom under the clamping portion. After removal of the cable 10 from thecable clamps 68, the connector 20 may then be removed from the tip 80 ofthe tensioner 50.

In an embodiment, the cable 10 may need to be retensioned after theconnector 20 has been removed from the tensioner 50. In this situation,the connector 20 may be reinserted into the tip 80 of the tensioner 50.The cable 10 may be secured against the tensioner 50 with the cableclamp 68 of the tensioner 50. The driver 56 may be inserted into theopening 44 of the pin 22. Under these circumstances the pin 22 may berotated by the driver 56 to an orientation which allows movement of thecable 10 through the connector body 24. The cable 10 may be retensionedby operation of the tensioner arm 54. When the desired tension isachieved, the cable 10 may be secured by the rotation of the pin 22within the connector 20.

Further modifications and alternative embodiments of various aspects ofthe invention will be apparent to those skilled in the art in view ofthis description. Accordingly, this description is to be construed asillustrative only and is for the purpose of teaching those skilled inthe art the general manner of carrying out the invention. It is to beunderstood that the forms of the invention shown and described hereinare to be taken as the presently preferred embodiments. Elements andmaterials may be substituted for those illustrated and described herein,parts and processes may be reversed, and certain features of theinvention may be utilized independently, all as would be apparent to oneskilled in the art after having the benefit of this description of theinvention. Changes may be made in the elements described herein withoutdeparting from the spirit and scope of the invention as described in thefollowing claims

What is claimed is:
 1. A method of surgically implanting a surgicalcable system comprising: passing a cable through a connector body,around a human bone element, and back through the connector body to forma loop; coupling a tensioner to the connector body, the cable, and to apin, wherein a side surface of the pin is positioned in a workingrelationship relative to the connector body and to the cable; tensioningthe cable with the tensioner; and rotating the pin with the tensioner tocouple together the side surface, the cable and the connector body sothat movement of the cable with respect to the connector body isinhibited during use.
 2. The method of claim 1 wherein the loopencircles at least two vertebrae of a human spine.
 3. The method ofclaim 1 wherein the loop encircles a spinal fixation device and avertebra of a human spine.
 4. The method of claim 1 wherein passing thecable through the connector body comprises passing the cable into afirst face of the connector body and out through a second face of thebody, and wherein passing the cable back through the connector bodycomprises passing the cable into the second face and out through thefirst face.
 5. The method of claim 1 wherein passing the cable throughthe connector body comprises passing the cable into a first face of theconnector body and out through a second face of the body, and whereinpassing the cable back through the connector body comprises passing thecable into the first face and out through the second face.
 6. The methodof claim 1 wherein the loop is formed such that both ends of the cableextend out from the connector body.
 7. The method of claim 1 wherein theloop is formed such that both ends of the cable extend out from theconnector body, and wherein both ends of the cable are secured to thetensioner prior to tensioning the cable.
 8. The method of claim 1 hereinthe loop is formed such that a first end of the cable is secured by theconnector body, and wherein a second end of the cable extends out fromthe connector body.
 9. The method of claim 1 wherein the pin ispositioned within the connector body prior to passing the cable throughthe connector body.
 10. The method of claim 1 wherein a first end of thecable is sized to inhibit passage of the cable through a passage in thepin, and wherein the loop is formed by passing a second end of the cablethrough the passage, around the human bone element, and through theconnector body such that a portion of the cable is positioned between awall of the connector body and an outer surface of the pin.
 11. Themethod of claim 1 wherein tensioning the cable comprises using thetensioner to hold the connector body in place while pulling the cablethrough the connector body.
 12. The method of claim 1 wherein tensioningthe cable comprises moving a shaft of the tensioner in a directionopposite to a direction of movement of the cable through the connectorbody.
 13. The method of claim 1 further comprising inserting the pininto the connector body after tensioning the cable.
 14. A method ofsurgically implanting a surgical cable system comprising: passing acable through a connector body, around a human bone, and back throughthe connector body to form a loop; tensioning the cable; rotating a pinpositioned within the connector body to inhibit movement of the cablewith respect to the connector body; adjusting the position of the humanbone to release cable tension; rotating the pin to allow movement of thecable with respect to the connector body; coupling a tensioner to theconnector body, the cable and to the pin; tensioning the cable with thetensioner; and rotating the pin with the tensioner to inhibit movementof the cable with respect to the connector body.
 15. The method of claim14 wherein the human bone is a human spinal vertebra.
 16. The method ofclaim 14 wherein the loop encircles portions of at least two vertebraeof a human spine.
 17. The method of claim 14, wherein rotating the pinwithin the connector body to the first position comprises engaging thepin with a portion of the tensioner and rotating the tensioner portionto rotate the pin.
 18. The method of claim 14, wherein the loopencircles a portion of a spinal fixation device and a portion of atleast one vertebra of a human spine.
 19. The method of claim 14, whereinpassing the cable through the connector body comprises passing a portionof the cable through a passage that runs through the pin.
 20. The methodof claim 14, wherein coupling the tensioner to the pin comprisespositioning a tool end of the tensioner in a tool opening of the pin.21. The method of claim 14, wherein rotating the pin to allow movementof the cable comprises rotating the pin with the tensioner.
 22. Themethod of claim 14, wherein coupling the tensioner to the connector bodycomprises placing the connector body in a tip of the tensioner, whereincoupling the tensioner to the cable comprises fixing a portion of thecable to the tensioner, and wherein tensioning the cable with thetensioner comprises changing the position of the tip relative to thefixed portion of cable to apply tension to the cable.
 23. A surgicalcable system comprising: a body comprising an internal cavity; a cableadapted to pass through the body to form a loop for engaging a portionof a human bone during use; a pin rotatable within the internal cavityduring use to a first position for coupling a side surface of the pin, aportion of the cable and a portion of the body together to fix a size ofthe loop during use, and wherein the pin is rotatable to a secondposition, subsequent to fixing the size of the loop, such that the cableis moveable relative to the body to allow the size of the loop to bealtered during use; and a tensioner configured to couple to theconnector body, the cable and the pin, wherein the tensioner isconfigured to vary the tension of the cable and wherein the tensioner isconfigured to rotate the pin to the first position during use.
 24. Thesurgical cable system of 23 wherein the tensioner comprises a recessedopening, the recessed opening comprising a shape complimentary to theconnector.
 25. The surgical cable system of 23 wherein the tensionercomprises a body, the body comprising a cable clamp, and wherein thecable clamp is adapted to inhibit movement of a portion of the cablewith respect to the body.
 26. The surgical cable system of claim 23wherein the human bone is a human spinal vertebra.
 27. The system ofclaim 23, wherein the connector body comprises titanium.
 28. The systemof claim 23, wherein the cable comprises a stranded metal cable.
 29. Amethod of using a connector comprising a connector body and a pin forsurgically implanting a surgical cable system comprising: passing acable through the connector body, around a human bone element, and backthrough the connector body to form a loop, wherein a first section ofcable and a second section of cable are within the connector body duringuse, and the pin is between the first section of cable and the secondsection of cable; coupling a tensioner to the connector body, a pin, andthe cable; tensioning the cable with the tensioner; and rotating the pinwith the tensioner to secure the first section and the second section ofthe cable against the pin and against the connector body.
 30. The methodof claim 29 wherein passing the cable through the connector bodycomprises passing the cable into a first face of the connector body andout through a second face of the body, and wherein passing the cableback through the connector body comprises passing the cable into thesecond face and out through the first face.
 31. The method of claim 29wherein passing the cable through the connector body comprises passingthe cable into a first face of the connector body and out through asecond face of the body, and wherein passing the cable back through theconnector body comprises passing the cable into the first face and outthrough the second face.
 32. The method of claim 29 wherein the loop isformed such that both ends of the cable extend out from the connectorbody.
 33. The method of claim 29 wherein the loop is formed such that afirst end of the cable is secured by the connector body, and wherein asecond end of the cable extends out from the connector body.
 34. Themethod of claim 29 wherein the pin is positioned within the connectorbody prior to passing the cable through the connector body.
 35. Themethod of claim 29 wherein the loop is formed such that a first end ofthe cable is contained by a pin positioned within the connector body,and wherein a second end of the cable extends out from the connectorbody.
 36. The method of claim 29 further comprising passing the cablethrough the pin prior to passing the cable around the human boneelement.
 37. The method of claim 36 wherein tensioning the cablecomprises pulling a first end of the cable such that the cable issecured by the pin, and further comprising pulling a second portion ofthe cable through the connector body.
 38. The method of claim 29 furthercomprising inserting the pin into the connector body after tensioningthe cable.
 39. The method of claim 29 wherein the human bone element isa human spinal vertebra.
 40. A method of using a tensioner forsurgically implanting a surgical cable system comprising: passing acable around a human bone element and through a connector to form aloop, the connector comprising a body and a pin; tensioning the cablewith the tensioner such that a first direction of movement of a shaft ofthe tensioner is opposite to a second direction of movement of the cablethrough the connector; coupling the tensioner to the pin; and using thetensioner to secure the cable within the connector by pressing the cableagainst the body with a side surface of the pin while maintainingtension in the cable with the tensioner.
 41. The method of claim 40wherein the loop is formed such that two end portions of cable extendout from the connector, and wherein the both end portions of the cableare secured to the tensioner prior to tensioning.
 42. The method ofclaim 40 wherein the loop is formed such that a first end of the cableis secured by the connector, and wherein a second portion of the cableextends out from the connector, and wherein the second portion of thecable is secured to the tensioner prior to tensioning.
 43. The method ofclaim 40 further comprising positioning the connector within a tip ofthe tensioner prior to tensioning the cable.
 44. The method of claim 40further comprising securing the cable to the tensioner prior totensioning the cable.
 45. The method of claim 40 further comprisingsecuring a portion of the cable underneath a cable clamp lever prior totensioning the cable.
 46. The method of claim 40 further comprisingsecuring a first portion of the cable with a first cable clamp, andfurther comprising securing a second portion of the cable with a secondcable clamp, and wherein both portions of the cable are secured prior totensioning the cable.
 47. The method of claim 40 wherein tensioning thecable comprises the tensioner concurrently holding the connector inplace and pulling the cable through the connector until the tension ofthe cable reaches a predetermined amount.
 48. The method of claim 40wherein the human bone element is a human spinal vertebra.
 49. Asurgical cable system comprising: a body comprising an internal cavity;a pin positioned within the body, wherein the pin comprises a passage; acable positioned through the passage and between the body and the pinsuch that the cable forms a loop, wherein an end of the cable is sizedto inhibit the cable from passing through the pin; a driver configuredto couple to the pin, wherein rotating a portion of the driver to afirst position rotates the pin to secure the cable to the pin and thebody, and wherein rotating the portion of the driver to a secondposition releases the cable and allows the cable to move relative to thebody; and a tensioner adapted to vary the tension of the cable duringuse, wherein the driver and the tensioner are configured as portions ofan instrument.
 50. The system of claim 49, wherein the tensioner and thedriver are portions of a single tool.
 51. The system of claim 49,wherein the tensioner comprises a cable clamp and a shaft, and wherein aposition of a tip of the shaft is movable relative to a position of thecable clamp.
 52. The system of claim 49, wherein the cable comprises aleader portion and a main body, and wherein the leader portion hassufficient rigidity to guide the cable through the body.
 53. The systemof 49, wherein the tensioner comprises a tensioner body and a cableclamp, and wherein the cable clamp is adapted to inhibit movement of aportion of the cable with respect to the tensioner body.
 54. The systemof claim 49, wherein the tensioner comprises a recessed opening, therecessed opening comprising a shape complimentary to a portion of thebody.
 55. The system of claim 49, wherein the cable comprises strandedmetal wire.
 56. The system of claim 49, wherein the body comprisestitanium.
 57. The system of claim 49, wherein the pin comprisestitanium.
 58. A method of surgically implanting a surgical cable systemcomprising: passing a cable through a connector, around a human boneelement, and back through the connector to form a loop, the connectorcomprising: a body, the body comprising an internal cavity, a duct, anda projection, the duct communicating with the internal cavity, theprojection comprising an opening; a cable configured to pass through theduct to form a loop for engaging a portion of a bone during use, whereina portion of the cable extends into the internal cavity during use; anda pin comprising a protrusion; wherein the pin is positionable withinthe internal cavity during use in a first position for securing theportion of the cable with respect to the body, and wherein the pin ispositionable in a second position during use such that the cable ismoveable relative to the body during use; and wherein the pin isconfigured to rotate in a first direction into the first position, andwherein the protrusion is configured to engage a first surface of theprojection that defines the opening to inhibit rotation of the pin in asecond direction that is opposite to the first direction while allowingfurther rotation in the first direction during use; tensioning the cableusing a tensioner; and rotating the pin within the connector body to thefirst position.
 59. The method of claim 58 wherein the loop encircles atleast two vertebrae of a human spine.
 60. The method of claim 58 whereinpassing the cable around a human bone element further comprises passingthe loop through a passage formed in a bone.
 61. The method of claim 58wherein the loop encircles a spinal fixation device and a vertebra of ahuman spine.
 62. The method of claim 58 wherein the connector furthercomprises a first duct and a second duct, and wherein passing the cablethrough the connector comprises passing the cable through a first face,into the first duct, and out through a second face of the body, andwherein passing the cable back through the connector body comprisespassing the cable through the first face, into the second duct, and outthrough the second face.
 63. The method of claim 58 wherein the loop isformed such that both ends of the cable extend out from the connectorbody.
 64. The method of claim 58 wherein the loop is formed such thatboth ends of the cable extend out from the connector body, and whereinthe both ends of the cable are secured to the tensioner prior to thetensioning the cable.
 65. The method of claim 58 wherein the pin ispositioned within the connector prior to passing the cable through theconnector.
 66. The method of claim 58 further comprising passing thecable through a passage through the pin prior to passing the cablearound the human bone element.
 67. The method of claim 58 furthercomprising positioning the connector within a tip of the tensioner priorto tensioning the cable.
 68. The method of claim 58 further comprisingsecuring the cable to the tensioner prior to tensioning the cable. 69.The method of claim 58 further comprising using a drive tool to rotatethe pin within the connector body.
 70. The method of claim 58 furthercomprising: varying the position of the pin within the connector topermit the cable to move within the connector body; retensioning thecable with the tensioner; and repositioning the pin within the connectorbody to secure the cable within the connector body.
 71. The method ofclaim 70 wherein varying the position of the pin comprises rotating thepin to the second position.
 72. The method of claim 70 wherein varyingthe position of the pin comprises removing the pin from the connectorbody.
 73. The method of claim 70 wherein repositioning the pin comprisesrotating the pin to the first position.
 74. The method of claim 70wherein repositioning the pin comprises inserting the pin into theconnector body so that the pin is in the first position.
 75. The methodof claim 70, wherein the projection includes a second surface definingthe opening, wherein rotation of the pin in the first direction past thesecond surface is deterred, and wherein varying the position of the pincomprises applying enough rotational force to the pin to rotate the pinpast the second surface to the second position.
 76. The method of claim70 wherein repositioning the pin comprises rotating the pin in the firstdirection such that the protrusion passes into the opening.
 77. Themethod of claim 58 wherein rotating the pin comprises rotating the pinin the first direction such that the protrusion passes into the opening.78. The method of claim 58 wherein the cable comprises a stranded metalcable.
 79. A method of surgically implanting a surgical cable systemcomprising: passing a portion of a cable through a pin, wherein a firstend of the cable is sized to pass through a passage in the pin andwherein a second end of the cable is sized to inhibit passage of thesecond end through the passage; passing the first end around a humanbone element, and through the connector body to form a loop; tensioningthe cable with a tensioner; coupling a drive tool to the pin, whereinthe tensioner and the drive tool are portions of an instrument; androtating the drive tool to couple the connector body, the cable and thepin together so that movement of the cable with respect to the connectorbody is inhibited during use.
 80. The method of claim 79, wherein thecable comprises stranded metal wire.
 81. The method of claim 79, whereinthe first end of the cable comprises a leader portion that has greaterrigidity than a main portion of the cable, wherein the leader portionfacilitates passage of the cable through the pin and the connector body.82. The method of claim 79, wherein the loop encircles portions of atleast two vertebrae.
 83. The method of claim 79, wherein the loopencircles a portion of at least one vertebrae and a portion of at leastone fixation device.
 84. The method of claim 79, wherein tensioning thecable comprises fixing a portion of the cable to the tensioner, andmoving the fixed portion of cable relative to the connector body toplace the cable in tension.
 85. The method of claim 79, furthercomprising releasing tension in the cable; rotating the pin to allow thecable to move relative to the connector body; retensioning the cablewith the tensioner; and rotating the pin to inhibit movement of thecable relative to the connector body.
 86. A method of using a connectorcomprising a connector body and a pin for surgically implanting asurgical cable system, comprising: passing a cable through a passage inthe pin, wherein a first end of the cable is sized to inhibit passage ofthe end through the pin; placing the cable around a human bone element;passing a second end of the cable between the connector body and the pinto form a loop; tensioning the cable with a tensioner; coupling aportion of the tensioner to the pin and turning the portion, so that thepin is rotated to a first position to inhibit movement of the pin andsecure a portion of the cable between the pin and the connector body.87. The method of claims 86, wherein tensioning the cable comprisescoupling a tensioner to the connector body and the cable; and moving thecable relative to the connector body to tension the cable.
 88. Themethod of claim 86, wherein the cable is a stranded metal wire.
 89. Themethod of claim 86, wherein the cable comprises a leader portion and amain body, wherein the leader portion has greater rigidity than the mainbody to facilitate passing the cable through the pin, around the humanbone element, and through the connector body.
 90. The method of claim86, wherein the pin and connector body are configured to resist rotationof the pin from the first position to a second position where the cableis movable through the connector body.
 91. The method of claim 86,further comprising rotating the pin to a second position where the pinis positioned so that the cable may be moved through the connector body,adjusting tension in the cable, and rotating the pin to the firstposition.
 92. The method of claim 86, wherein the loop encirclesportions of at least two vertebrae.
 93. The method of claim 86, whereinthe loop encircles a portion of at least one vertebra and a portion ofat least one fixation device.